Gynecology Book

http://www.fpnotebook.com/

Uterine CancerAka: Endometrial Carcinoma, Endometrial Cancer

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  1. Epidemiology
    1. Most common gynecologic tract cancer
      1. Incidence 1.5 times more common than ovarian
      2. Incidence 3 times more common than cervical
    2. Statistics from 1995
      1. Incidence: 32,000 new cases per year
      2. Mortality: 5900 deaths per year
  2. Risk Factors
    1. See Endometrial Cancer Risk Factors
  3. Pathophysiology
    1. Endometrial Hyperplasia progresses to cancer
      1. Atypical Hyperplasia: cancer in 20-25% by 1 year
      2. Complex Hyperplasia: cancer in 10% by 3 years
  4. Protective
    1. Oral Contraceptive use
    2. Estrogen Replacement Therapy with Progesterone
    3. Tobacco abuse
    4. High parity
  5. Terminology
    1. Traditional
      1. Cystic hyperplasia (Swiss cheese hyperplasia)
      2. Adenomatous hyperplasia without atypia
      3. Atypical adenomatous hyperplasia
      4. Adenocarcinoma in situ
    2. ISGYP 1988 terminology
      1. Simple hyperplasia
      2. Complex hyperplasia
      3. Atypical hyperplasia with architectural atypia
  6. Diagnosis
    1. Ultrasound Pelvis (Postmenopause without HRT)
      1. Endometrial Stripe
        1. Greater than 5mm sugests hyperplasia
        2. Increased by Estrogen Replacement and Tamoxifen
    2. Endometrial Biopsy
  7. Indications for Referral
    1. Patients with Cancer or atypical hyperplasia
    2. Patients who fail usual sampling
    3. Patients who fail conservative therapy
      1. Hyperplasia
      2. Perimenopausal Dysfunctional Uterine Bleeding
      3. Anovulatory Dysfunctional Uterine Bleeding

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